336426511-4-14-2022-56-AS-EMAN-CSCV29-20230531160240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 04/14/2022
Date Signed: 04/14/2022 03:28:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2022 and conducted by Evaluator Jennifer Semin

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220411153553

FACILITY NAME:	AVISTA SENIOR LIVING MAGNOLIA		FACILITY NUMBER:	336426511
ADMINISTRATOR:	MONIQUE DEL JUNCO		FACILITY TYPE:	740
ADDRESS:	737 MAGNOLIA AVE		TELEPHONE:	(951) 737-1600
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	180	CENSUS: 116	DATE:	04/14/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Blasia Lee-Lole and Rona Sanchez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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9

Resident not being administered medication as prescribed.
Staff did not assist resident with feeding(s).

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Jennifer Semin and Ryan Gardner arrived to the facility unannounced to initiate a complaint investigation into the above complaint allegations and deliver the findings. LPA met with Administrator, Blasia Lee-Lole and Business Office Manager (BOM) Rona Sanchez.
The investigation consisted of interviews and review of records. The first allegation, Resident not being administered medication as prescribed. Staff stated all medication is given according to doctor’s order. Medication prescriptions are given between 8am-9am, 11am-12pm, 4pm-5pm, and 8pm-9pm unless a specific time is documented on the prescription orders. Resident interviewed stated all medication is given on time and according to their doctor’s order.
The second allegation, Staff did not assist resident with feeding(s). Staff stated they do assist residents with feedings if needed. Staff stated there are currently no residents that require assistance with feedings. Residents interviewed stated they do not need assistance with feeding nor have they seen any resident requiring feeding assistance.
Based upon interviews and information gathered, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.
An exit interview was conducted where this report was discussed and provided to the BOM.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Jennifer Semin	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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